News Article

Research of Jonathan M. Spector, MD, MPH

Jonathan M. Spector, MD, MPH

Assistant Pediatrician, Newborn Services, Massachusetts General HospitalResearch Associate, Harvard School of Public HealthInstructor in Pediatrics, Harvard Medical School

Dr. Spector's research contributions are in the area of outcome-oriented public health strategies that positively impact global maternal, newborn, and child survival. A particular focus is innovative health system tools and programs that improve service delivery at the moment of care by frontline health workers in low and middle income countries.

The risk of childbirth-related complications is increasingly well understood. Of the 130 million births that take place each year, the World Health Organization (WHO) estimates that more than 3 million deaths occur in the neonatal period, up to half a million women die of childbirth- related causes, and 1 million intrapartum-related stillbirths occur. The greatest burden of maternal and perinatal mortality is clustered around the time of birth with the majority of deaths occurring within the first 24 hours after delivery. In many countries, little or no progress has been made towards achieving Millennium Development Goals 4 (reducing child mortality rates) and 5 (reducing the maternal mortality ratio).

Since 2008, Dr Spector has served as technical lead for WHO Patient Safety's Safe Childbirth Checklist Program. This partnership effort of WHO and the Harvard School of Public Health, in collaboration with a broad network of international experts in maternal and newborn health, aims to develop, evaluate, and distribute a checklist-based childbirth safety program that enhances health workers' capacity to deliver high quality maternal and perinatal care for institutional births. The program was developed through a systematic process that involved international consultations and early field testing for usability in 10 countries in sub-Saharan Africa and Asia. A formal pilot trial of the program's impact on health worker performance was completed in December, 2010. Preliminary results are encouraging. Future work will likely include larger-scale testing that measures the checklist program's impact on health outcomes.

Dr Spector is grant-funded to develop and test technology for improving newborn resuscitation practice in resource-limited settings. Birth asphyxia, the failure of babies to breathe at birth, causes more than one million deaths each year. Neonatal resuscitation is a widely accepted, reliable, and inexpensive method to help babies breathe, and yet is not uniformly practiced in many resource-poor countries where the vast majority of newborn deaths occur. Resuscitation training programs have long disseminated skills and knowledge, but there has been little attention focused on the design and development of novel, resource-appropriate technology that provides a safe and effective space for neonatal resuscitation. The Newborn Rescue Cot (NRC)TM is an award-winning (Harvard Business School Social Enterprise competition) approach to saving newborn lives in low-income countries by providing a designated, safe platform for neonatal resuscitation. Consistent with its inventive configuration, the device serves as a valuable memory aid that prompts reminders of clinical algorithms endorsed by WHO, the American Academy of Pediatrics, and UNICEF. Dr. Spector is leading a multi-disciplinary team with extensive experience in global newborn survival and product development to produce functional NRC prototypes. Field-testing in Kenya in 2011 will confirm the NRCs capacity to improve the quality and safety of healthcare at the time of birth. Project success will ultimately be measured by demonstrating improved adherence by healthcare workers to accepted standards of resuscitative care, and by improved health outcomes.

Dr Spector is also involved in increasing accessibility and usability of neonatal IMCI (Integrated Management of Childhood Illness) through transformation of these protocols onto mobile communication device platforms in Tanzania. Prior to his current activities, Dr Spector led a large- scale national study in Panama investigating the impact of training curricula on outcomes of transported newborns (see Figure).

Figure: Improved thermal management was demonstrated following national rollout in Panama of an educational course for health workers to assure safe neonatal transport. The darkly shaded area represent temperatures in the normal range (p<0.01).